From risk to resilience: Lessons from India’s devastating second COVID wave

Five years later, the summer of 2021 still evokes a distinct and unsettling memory. There was an eerie feeling, a growing sense that something unprecedented was unfolding, even before its full scale became apparent. This was very different from the first wave. Cases were rising rapidly, but so too was the severity of illness. Hospitals were filling at an alarming pace, oxygen demand was escalating, and mortality was increasing across the country. In terms of deaths occurring over such a short time span, the only comparable event was the tragedy of Partition.

The first indications of the impending crisis emerged through discussions within disaster-response and public-health networks. What initially appeared to be concerns about oxygen availability soon revealed itself as a much broader systems challenge. It became increasingly clear that the crisis would not be defined by a shortage of a single resource, but by cascading failures across interconnected systems, that is, oxygen supplies, ambulances, hospital beds, referral pathways, healthcare personnel, and eventually even funeral services. One enduring lesson from that period is that pandemics are fundamentally systems crises. Failure rarely occurs at a single point; it spreads rapidly across interconnected sectors.

As the situation deteriorated, another reality became apparent. Given the looming oxygen shortages and mounting pressure on hospitals, the safest strategy for many people was simply not to become infected. There was a growing awareness that once healthcare systems became overwhelmed, avoiding exposure might be the only protection available to thousands of individuals. Yet there was also a profound sense of helplessness. The warning signs were visible, but there were limited mechanisms to communicate the urgency of the situation or translate risk into behavioural change. The experience highlighted a central challenge of crisis management: early warning is useful only if it leads to timely action.

By the end of April, the anticipated pressures had become reality. Hospitals were operating beyond capacity, healthcare workers were exhausted, and information systems struggled to keep pace with rapidly evolving events. Operational realities were often visible long before they appeared in official statistics. The experience reinforced a fundamental emergency-management principle: decision-makers cannot wait for perfect information during fast-moving crises. Data almost always lags behind events, requiring action under conditions of uncertainty.

During this period, a virtual incident command system supported by the European Union brought together a small group of experts to help locate hospital beds, connect patients with healthcare providers, facilitate referrals, and support evacuation planning when local systems became overwhelmed. The experience demonstrated the value of incident-command principles even in virtual settings. Shared situational awareness, clear communication, defined responsibilities, and rapid coordination proved essential in managing complexity under extraordinary pressure.

One of the most important lessons concerned triage. Triage is often viewed narrowly as a hospital function, but pandemics require triage across the continuum of care. While hospitals attempted to prioritise admissions according to severity, the principle was inconsistently applied elsewhere. Equally significant was the absence of effective discharge triage. During periods of severe bed shortages, every unnecessary day of hospitalisation reduced the system's ability to accommodate critically ill patients.

An even greater gap existed at the community level. Thousands of families were attempting to manage illness at home without clear guidance regarding who required hospital care, who could be safely monitored, and when escalation was necessary. In response, a group of medical college alumni collaborated to develop simple, evidence-based home-triage guidelines to help families assess severity, identify warning signs, and make informed decisions regarding care-seeking.

These guidelines were disseminated widely through professional and community networks. The experience underscored a critical lesson in public health emergency management: effective triage begins in the community, long before a patient reaches a hospital. Empowering families with clear, accessible guidance can be as important as expanding hospital capacity in reducing avoidable morbidity and mortality during health crises.

One image from that period remains permanently etched in memory: the aerial photograph of countless funeral pyres burning through the night. It conveyed the magnitude of loss more powerfully than any epidemiological curve or mortality statistic ever could. Behind every pyre was a family confronting grief and uncertainty. Across the country, children were orphaned, spouses widowed, and communities scarred by loss. It was a reminder that pandemics are ultimately human crises, measured not only in numbers but in lives and futures irrevocably altered.

Today, as the world confronts Ebola and Hantavirus, these lessons remain highly relevant. Future pandemics may differ in their epidemiology, but the principles of crisis management remain constant: anticipate cascading failures, communicate risk early, establish incident-command structures, implement triage across the continuum of care, support community decision-making, and build resilience before it is needed. The next pandemic may be years away, or it may already be emerging. The challenge is to ensure that the lessons learned at such tremendous human cost in 2021 are not forgotten.

The author is an ICRC and WHO-trained disaster management specialist associated with the Pahle India Foundation; Views presented are personal.